Provider Demographics
NPI:1083932040
Name:VIOLETTE, TARA ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ELIZABETH
Last Name:VIOLETTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4342
Mailing Address - Country:US
Mailing Address - Phone:603-447-6690
Mailing Address - Fax:
Practice Address - Street 1:1623 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5157
Practice Address - Country:US
Practice Address - Phone:603-356-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3113183500000X
MAPH23823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist